What is included in the long-term monitoring of pediatric adrenal insufficiency (Addison disease)?

Updated: Dec 07, 2018
  • Author: Kimberly Tafuri, DO; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

In a child with adrenal insufficiency (Addison disease), long-term glucocorticoid replacement must be balanced between the need to prevent symptoms of adrenal insufficiency and the need to allow the child to grow at a normal rate, because excess replacement with glucocorticoid diminishes growth velocity.

Hydrocortisone is available in 5-mg, 10-mg, and 20-mg tablets. This agent is recommended for long-term therapy because of its relatively low potency, which eases the titration of appropriate doses.

In a large patient, prednisone or dexamethasone may be substituted; however, individual sensitivity to these drugs widely varies. Estimated equivalencies are as follows: [59]

  • 1 mg of prednisone = typically given as 4-6 mg of hydrocortisone, but may be up to 15 mg

  • 1 mg of dexamethasone = 40-100 mg of hydrocortisone

Patients with primary adrenal insufficiency who also have mineralocorticoid deficiency require fludrocortisone at 0.1-0.2 mg/d. Young patients must be given adequate access to sodium chloride (typically 2-4 g/d) to counteract salt wasting.

If the patient's adrenal insufficiency has an autoimmune etiology, monitor patients for the development of associated autoimmune phenomena, such as hypoparathyroidism, hypogonadism, vitiligo, pernicious anemia, thyroid dysfunction, and diabetes mellitus.


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